Carpal Tunnel Syndrome Therapy

Sophie Matzik is a freelance writer for the medical team.

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Carpal tunnel syndrome therapy is started immediately after diagnosis. Delaying would mean exposing the nerve to further damage, which could exacerbate symptoms and sequelae. There are different treatment options for carpal tunnel syndrome: therapy using conservative methods or surgery. Read here which therapy is used in which cases and what happens in the process.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. G56

Carpal tunnel syndrome: therapy by stage

There are basically different treatment options for carpal tunnel syndrome. Depending on the severity of the disease and the symptoms, two therapy methods are used:

Conservative carpal tunnel syndrome therapy
Surgical carpal tunnel syndrome therapy

Your doctor will work with you to choose the best therapy option for you. The stage of the disease is decisive: In mild to moderate cases, an attempt is first made to alleviate the symptoms with conservative therapy. If this is not possible or if the symptoms represent a significant impairment of the everyday life of the person concerned, surgical therapy is recommended.

Carpal Tunnel Syndrome Therapy: Conservative Methods

In medicine, conservative means something like preserving. In the present case, this means carpal tunnel syndrome treatment without surgical intervention. Because an operation is always associated with certain risks.

When is conservative carpal tunnel syndrome therapy carried out?

Maintaining carpal tunnel syndrome therapy is indicated in all mild to moderate cases of illness. This means that those affected classify the pain as stressful, but not as completely restrictive in everyday life.

In general, conservative treatment is also used in young people, pregnant women and people whose carpal tunnel syndrome is a treatable disease (such as diabetes).

What are the conservative methods?

The symptoms of carpal tunnel syndrome can be alleviated by:

Nocturnal immobilization of the wrist: The wrist is fixed in the middle position at night using a special splint. During the day, the carpal tunnel syndrome splint, which is usually provided with a Velcro fastener, can be easily removed.
Cortisone: In certain cases it may be necessary to inject a cortisone preparation into the wrist or to take cortisone tablets. The injection is not without risk, as the tendons and nerves could be injured by the puncture.

If the carpal tunnel syndrome was triggered by excessive stress, it is essential to take care of the hand in order to avoid further overuse. If you have persistent discomfort while practicing your job, you should consider changing jobs.

Other conservative methods of carpal tunnel syndrome therapy that have been tried in the past, such as treatment with laser, yoga, or ultrasound, are not effective.

Carpal tunnel syndrome therapy: surgery

In many cases, those affected come to the doctor very late. The nerve is then usually so damaged that conservative therapy is no longer sufficient. An operation is therefore useful for the following diagnoses:

Failure of conservative carpal tunnel syndrome therapy after eight weeks
Severe pain at night
Persistent numbness
Greatly reduced values when measuring the nerve conduction velocity

Carpal tunnel syndrome surgery is performed by a hand or neurosurgeon under local anesthesia. It is usually done on an outpatient basis. After the operation, the wrist is immobilized with a wrist splint for a few days. The operation can be performed safely even if the patient is old and during pregnancy.

Two surgical procedures have become established in the past:

1. Open carpal tunnel syndrome surgery

In open carpal tunnel syndrome surgery, the surgeon cuts the ligament that is located above the groove on the wrist (carpal ligament). Tissue that is constricting the nerve is also removed. This gives the nerves and tendons more space. The incision during the operation runs in the longitudinal line of the palm, so it is hardly noticeable afterwards.

Open surgery is performed when the patient's wrist anatomy deviates from the norm, wrist mobility is limited, or it is a repeated procedure (recurrent surgery).

2. Endoscopic carpal tunnel syndrome therapy

In endoscopic surgery (also known as keyhole surgery), the surgeon inserts all of the instruments through an incision about one to two centimeters long across the flexion fold of the wrist. The actual operation then proceeds as with the open operation.

Both operations are equivalent in their results, but with the endoscopic operation the wrist can often be loaded again earlier. Conventional open carpal tunnel syndrome therapy is cheaper.

What happens after a carpal tunnel syndrome operation?

After the operation, you will first receive a plaster splint to immobilize your wrist. The affected arm must be kept completely still for a day, but you should start doing simple finger exercises the day after the operation to promote mobility and healing. To avoid swelling, the arm should be raised. In the first few days you can alleviate any pain with the help of pain relievers and cold packs.

After eleven days, the sutures over the surgical scar are removed. During this time, you should not lift anything heavy or lean on anything with that hand. When showering, you should put your hand in a plastic bag, as the bandages and threads must not get wet.

You can treat the scar with a commercially available fatty ointment; a special scar cream is not necessary.

The duration of the incapacity for work after an operation depends on the extent to which the hand is strained at work. As a rule, you are not allowed to work or exercise for three to four weeks after an operation. If the wrist is less stressed at work, it is possible to start earlier again, but often later if the wrist is heavily stressed. Clarify this with your doctor.

How you can support carpal tunnel syndrome therapy

In the case of advanced carpal tunnel syndrome, there is little you can do yourself, since changing the position of the hand or reducing the strain on the hand will alleviate the symptoms, but not eliminate the cause. In many cases, an operation is the only way to enable you to have a symptom-free life again. For the time after the carpal tunnel syndrome operation, however, there is some advice that you should follow in order to support the success of the therapy:

It is essential that you follow the surgeon's advice after the carpal tunnel syndrome operation. It is important that you begin finger exercise immediately, even if it hurts at the beginning, to maintain flexibility and promote healing. There are also exercises for the wrist with carpal tunnel syndrome that provide relief and promote mobility. At home, for example, you can stretch your arms straight out and bend your hands back 90 degrees with the outer surfaces facing your face. This is how you stretch your arms and wrists and promote a healthy healing process for carpal tunnel syndrome. Physiotherapy and exercises should be done for several weeks after carpal tunnel syndrome treatment.

An upright posture is also important in carpal tunnel syndrome.

Pain and swelling occurring after the operation are mostly caused by bandages that are too tight, insufficient movement of the fingers or excessive relieving of the hand and should not be confused with complications caused by the operation.

The splint and posture should be taken off after one to three weeks. You should then try to use your wrist as it was before the operation.

Persistent numbness

Complications of Carpal Tunnel Syndrome Therapy

The regression of numbness can take several weeks. Especially in severe cases in which the numbness was very pronounced, the regression can extend over several months. If there is still no improvement six months after the carpal tunnel syndrome therapy, you should make another appointment with the neurologist. Sometimes this persistent numbness can be remedied by a (renewed) surgical procedure. In severe cases - especially if the operation was performed too late - the numbness can persist for a lifetime.

In general, both surgical methods for carpal tunnel syndrome are considered to be very low-risk. The usual symptoms of an operation, such as bleeding, infections or swelling, rarely occur. However, other complications can arise depending on the surgical method.

Risks in open carpal tunnel syndrome surgery

In open surgery, the nerve or its branches can be damaged during the operation. As a result, sensory disturbances in the area of the fingers and balls of the thumb are possible. In extreme exceptional cases, there is a protracted, sometimes very painful, bone decalcification and soft tissue swelling, which can also result in joint stiffening (Sudeck's disease).

The scar can be painful for several weeks after the operation and be sensitive to touch or strain.

Risks of endoscopic carpal tunnel syndrome surgery

With endoscopic carpal tunnel syndrome therapy, the risk of injury to the nerve is greater, as the surgeon cannot fully understand the anatomy and possible special features of the wrist. Occasionally the operation has to be repeated if the carpal ligament has not been completely severed. The scar problems are less.

Sometimes endoscopic surgery is converted into open surgery during surgery because of bleeding or an unexpected wrist anatomy.

The "snap finger"

After both surgical procedures, a single finger may snap or be very painful. Then the tendon sheath was injured or pinched. This "snap finger" can be treated with an operation with local anesthesia. A snap finger occurs in around 20 percent of all cases, making it the most common complication in carpal tunnel syndrome therapy.

Carpal tunnel syndrome: homeopathy

Homeopathic applications (such as ointments) for carpal tunnel syndrome are advertised by many information sites on the Internet. However, their effectiveness in carpal tunnel syndrome therapy has not been scientifically proven.

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